Since many of the characteristics of multicomponent behavioral interventions for treating obesity are both patient-centered and involve self-management, the patient-centered medical home (PCMH) seems to be the ideal setting to deliver these interventions [13]. Specifically, PCMHs provide patient-centered care that is wide-ranging, team-based, and coordinated across all elements of the health care system and the patient’s community [14]. These sites specifically provide primary care, which is the type of care that obesity disparity patient groups such as racial/ethnic minorities, sexual minorities, groups with low incomes, and the medically underserved are more likely to utilize [15].
Providing multicomponent behavioral interventions for obesity in PCMHs and other primary care sites will increase the likelihood of participation among the aforementioned obesity disparity groups. Despite the potential benefits of obesity treatment interventions offered in primary care settings, particularly for obesity disparity groups, the role of primary care providers in providing such treatment interventions is not clear [16]. We surveyed primary care physicians who primarily worked in PCMHs to assess their practices, knowledge, views/beliefs, perceived barriers, and perceived needed clinic practice improvements relative to promoting healthy lifestyles and weight management among their patients.
Methods
Participants
Primary care physicians were recruited from among a regional primary care practice-based research network that includes 37 PCMHs affiliated with an academic health center and 2 nearby primary care sites not affiliated with an academic health center. Fifty-two physicians at these centers received an invitation via email to participate in our online survey study. The invitation email included (a) a study endorsement note from the chair of the Community Health and Family Medicine Department affiliated with the PCMHs, (b) instructions about how to participate in the study, and (c) a link to the study. Participation inclusion criteria specified in the online informed consent form were: (a) working as a physician affiliated with the practice-based research network, (b) having access to a computer with internet connection, (c) being able to communicate in written English, and (d) providing written consent to participate in the study. Physicians were not provided compensation for participating in the study.
Survey Instrument
To assess physicians’ views and practices, we used a modified version of the Physician Survey of Practices on Diet, Physical Activity, and Weight Control–Adult Questionnaire [17]. The survey was sponsored by the National Cancer Institute in collaboration with several other NIH institutes and the CDC for evaluating current clinical practices among physicians, including the degree to which physicians evaluate their patients for obesity and offer them guidance designed to increase adherence to a health-promoting lifestyle (eg, recommendations on diet, weight, and physical activity). Additionally, the questionnaire assesses physicians’ perceived barriers to patient assessment, evaluation, and management. It also includes questions about physicians’ healthy lifestyle–related knowledge. In 2010, Smith and colleagues utilized the questionnaire with a nationally representative sample of primary care physicians ( n = 1211) to investigate primary care physicians’ clinical practices in relation to overweight and obesity [18]. To our knowledge, no other physician survey has been developed to assess current engagement in recommended clinical practices, barriers to engaging in recommended practices, as well as beliefs and knowledge regarding helping patients follow a health-promoting lifestyle. The original survey also includes questions regarding the physicians’ personal health status and health behaviors.